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Journal article
Outcomes After Minimally Invasive Esophagectomy Review of Over 1000 Patients
Annals of surgery, v 256(1), pp 95-103
01 Jul 2012
PMID: 22668811
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: Esophagectomy is a complex operation and is associated with significant morbidity and mortality. In an attempt to lower morbidity, we have adopted a minimally invasive approach to esophagectomy.
Objectives: Our primary objective was to evaluate the outcomes of minimally invasive esophagectomy (MIE) in a large group of patients. Our secondary objective was to compare the modified McKeown minimally invasive approach (videothoracoscopic surgery, laparoscopy, neck anastomosis [MIE-neck]) with our current approach, a modified Ivor Lewis approach (laparoscopy, videothoracoscopic surgery, chest anastomosis [MIE-chest]).
Methods: We reviewed 1033 consecutive patients undergoing MIE. Elective operation was performed on 1011 patients; 22 patients with nonelective operations were excluded. Patients were stratified by surgical approach and perioperative outcomes analyzed. The primary endpoint studied was 30-day mortality.
Results: The MIE-neck was performed in 481 (48%) and MIE-Ivor Lewis in 530 (52%). Patients undergoing MIE-Ivor Lewis were operated in the current era. The median number of lymph nodes resected was 21. The operative mortality was 1.68%. Median length of stay (8 days) and ICU stay (2 days) were similar between the 2 approaches. Mortality rate was 0.9%, and recurrent nerve injury was less frequent in the Ivor Lewis MIE group (P < 0.001).
Conclusions: MIE in our center resulted in acceptable lymph node resection, postoperative outcomes, and low mortality using either an MIE-neck or an MIE-chest approach. The MIE Ivor Lewis approach was associated with reduced recurrent laryngeal nerve injury and mortality of 0.9% and is now our preferred approach. Minimally invasive esophagectomy can be performed safely, with good results in an experienced center.
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Details
- Title
- Outcomes After Minimally Invasive Esophagectomy Review of Over 1000 Patients
- Creators
- James D. Luketich - University of PittsburghArjun Pennathur - University of PittsburghOmar Awais - University of PittsburghRyan M. Levy - University of PittsburghSamuel Keeley - University of PittsburghManisha Shende - University of PittsburghNeil A. Christie - University of PittsburghBenny Weksler - University of PittsburghRodney J. Landreneau - University of PittsburghGhulam Abbas - University of PittsburghMatthew J. Schuchert - University of PittsburghKatie S. Nason - University of Pittsburgh
- Publication Details
- Annals of surgery, v 256(1), pp 95-103
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 9
- Grant note
- K07CA151613 / NATIONAL CANCER INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI) K07 CA151613 / NCI NIH HHS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Cancer Institute (NCI)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000306083300017
- Scopus ID
- 2-s2.0-84863332251
- Other Identifier
- 991021960801004721
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- Surgery